Funder: Arnold Ventures

Author: Brianna Ensslin Janoski, Independent Consultant; Tom Betlach, Speire Healthcare Strategies; and Michelle Herman Soper, Center for Health Care Strategies

October 2020 | Report


As the COVID-19 pandemic has unfolded, it has become evident that people who are dually eligible for Medicare and Medicaid are among the nation’s most at-risk for and vulnerable to the virus. With this group of individuals largely receiving care in uncoordinated, fragmented systems, it is critical to identify opportunities to strengthen programs and policies to best support this population during the pandemic and in the future. Integrated care programs offer opportunities to align enrollment, care coordination, and incentives across payers and providers to support positive health and care outcomes. Yet, while there has been significant progress over the last decade to integrate services for this population, today only 10 percent of the 10 million full benefit dually eligible individuals are currently served in an integrated program.

This report, developed by Speire Healthcare Strategies and CHCS with support from Arnold Ventures, distills insights about COVID-19 response efforts from states and health plans that offer integrated programs. It outlines recommendations to support integration, including suggestions to:  (1) increase alignment between Medicare and Medicaid; (2) increase health plan flexibilities to meet member needs; (3) pay family caregivers and support other efforts to expand the workforce; (4) expand supplemental benefit offerings; (5) improve communication and data sharing; and (6) ensure fiduciary oversight.